Fighting the flu: The health-care system puts new strategies in place

Wednesday

Sep 16, 2009 at 2:00 AM

In June, Jessica Spencer came down with a fever of 103 degrees. "I felt achy and hot," the 14-year-old said. Additionally, she was coughing a lot. Jessica's father, Dr. Gregory Spencer of Crystal Run Healthcare, recognized the symptoms right away and whisked his daughter to Urgent Care.

Sheldon Scruggs

In June, Jessica Spencer came down with a fever of 103 degrees. "I felt achy and hot," the 14-year-old said. Additionally, she was coughing a lot. Jessica's father, Dr. Gregory Spencer of Crystal Run Healthcare, recognized the symptoms right away and whisked his daughter to Urgent Care.

"They swabbed my nose with a Q-tip (for testing) and gave me Tamiflu (one of two recommended drugs for treating influenza)," Jessica said. "I didn't feel like drinking a whole lot. But I knew that keeping fluids in me was good, so I forced myself to drink water."

Jessica ate normally after the second day of her illness and began to feel better on the fourth day. However, she remained out of Goshen Middle School for a week, even after her fever returned to normal.

The test she took at Urgent Care was not conclusive, but her father, the chief medical officer at Crystal Run, believes that what his daughter had was the influenza A virus, of which the H1N1 or swine flu is a strain.

"Some people may have had the swine flu strain and not have known it," Spencer said. "They still recovered quickly. Statistically, more people recover from the H1N1 virus than those who die from it."

Spencer said Crystal Run is vaccinating patients with the seasonal flu vaccine, but warned that it will not help against the H1N1 strain.

"When we do receive the H1N1 vaccines, our providers will be vaccinated. But if we reach crisis proportions, Crystal Run will follow the CDC's (Centers for Disease Control and Prevention) recommendations for who will be first among patients to be vaccinated."

No one is sure how bad the anticipated swine flu (H1N1 virus) will be in the United States. The CDC says this novel strain has the potential to cause up to 90,000 deaths this flu season — that's three times the number of deaths that occurred last year because of the seasonal flu.

How will our area be affected this fall and winter?

Dr. Mark Tack, as head of the Prevention and Infection Control Department for Benedictine and Kingston hospitals, is an infectious disease specialist. "It's my job to worry about pandemic flus," he said. "And the World Health Organization (WHO) has already declared the H1N1 virus a pandemic. Can a crisis happen in our region? Listen, I'm not an alarmist, but it's always good to be prepared for the worst."

Ulster County has a pandemic-planning committee that morphed from the bioterrorism committee formed after 9/11. An emergency plan was formulated so that hospitals, emergency and health-care workers in that area will know what to do in the case of an influenza outbreak.

"In the case of an outbreak," said Tack, "hospitals will have to follow the recommendations of the CDC and the county and state health departments. Based on their recommendations, Benedictine and Kingston will direct people to designated areas to receive H1N1 vaccines (places such as schools, health centers, government offices and the like)."

Other hospitals, doctors and health-care professionals have been monitoring and devising plans in case this virus reaches crisis proportions.

"We expect increased cases of the flu this season," said Dr. David Markenson, chief of pediatric emergency medicine at Maria Fareri Children's Hospital, a part of Westchester Medical Center. "Technically, we are ready for any disaster, including the swine flu should it reach crisis proportions."

Markenson said Westchester Medical Center is at the top of the emergency pyramid as a tertiary resource for emergency disasters. This means it provides resources, education, technical assistance and manpower, if necessary, to all medical facilities throughout the region.

The hospital also runs regular communication drills to make sure its staff is in constant contact with all the other hospitals in the area and with county and state health departments. The hospital also runs simulation drills to help any hospital evaluate its own preparedness in an emergency. Supplies and workers may be sent from one place to another to determine how quickly medications and vaccines can reach points of distribution.

'"There is a legitimate concern for a crisis," said Dr. John Fiore, medical director for Park Manor Rehabilitative Center in Middletown, the Montgomery Nursing Home in Montgomery and the Schervier Pavilion in Warwick. Serving the older residents of Orange County, his facilities will be prepared, Fiore said.

"We had one (an outbreak) in 1918 and there were a lot of fatalities. We have a seasonal flu vaccine available for all of our residents and 90 percent of them are inoculated. And we heavily promote it among our staff. The thing about the swine flu is that it spreads quickly, but doesn't cause many deaths (relatively speaking). Still, we are going to follow CDC reports and recommendations."

Fiore said he is pushing a lot of commonsense preventive measures, such as hand washing, cough etiquette and for employees and family members to stay away from the facilities when they are sick. If they must come in to a facility when ill, masks, gloves and gowns will be provided.

The CDC has published on its Web site that the elderly are not as high a risk for the swine flu as once designated. Fiore said this could be because those 65 years and older were already exposed to and developed immunities to certain kinds of viral infections.

"Yes, young children are particularly susceptible to this virus," said Dr. Richard Fuchs, a pediatrician with Hudson Valley Pediatrics. "Their immune systems are not strong yet."

Fuchs said they will follow the CDC's guidelines and procedures for inoculating.

"But the medical community can do only but so much," he said. "A prevention approach is the key to good health and that's the work of parents and educators."

Pregnant women are potentially at the greatest risk for this virus. "The very fact that a woman is pregnant makes her and her unborn baby vulnerable to this disease," said Dr. Howard Blanchette, chief of obstetrics and gynecology at Westchester Medical Center. "The woman is literally supporting two lives and her immune system is weak."

Blanchette said the H1N1 infection carries an increased risk of miscarriage or premature labor.

"The medical community can only make assumptions based on previous pandemics, like the one in 1918, when there was a high fetal and infant mortality rate."

The doctor also explained that the mother may suffer respiratory problems herself. Those with strong immune systems may recover quickly with antiviral medications. But since doctors have no way of knowing who's strong and who isn't, he strongly recommends all pregnant women get inoculated with the seasonal and H1N1 vaccine as soon as it becomes available.

Other hospitals in our area are making preparations, too.

"If things reach a crisis level, we intend to follow the emergency guidelines of the Sullivan County Health Department," said Dr. Rolland Bojo, director of infection control and disaster preparedness at Catskill Regional Medical Center in Sullivan County.

"Right now we are offering the seasonal flu vaccines and have administered those shots to all our employees. We have a POD (points of distribution) plan that will get people to specific places to receive H1N1 shots. We run periodic disaster drills with other medical facilities in the Hudson Valley, and this includes the Keller Army Community Hospital at West Point. If necessary, we will request additional resources from the county, state and lastly, the federal government. We like to think that we will handle anything that comes down the pipe."

At the Arden Hill campus of Orange Regional Medical Center, it's mandatory for all health employees to receive flu shot vaccinations, said Jonathan Schiller, vice president of administration. "Patients already under our care will be vaccinated. Further, we will work closely with the CDC and the state and county departments of health to get the public vaccinated when the vaccines are available.

"Orange Regional has an Incident Command Center on each campus (Arden Hill and Horton), which will employ the necessary protocols specific to that area," Schiller said. "We have an agreement with all the hospitals in the Hudson Valley to share resources and beds. We also have a means of keeping the public informed (through radio, TV and the newspapers)."

At St. Luke's Cornwall Hospital, Dr. Christine Jelalian, medical director, said, "We constantly review Department of Health and CDC recommendations and guidelines for screening, testing, isolation and treatment (for viruses). We have a contingency plan for dealing with communicable diseases to ensure adequate availability of supplies and medication. Also, we have a mutual aid agreement with hospitals in seven counties.

"During a communicable-disease outbreak, people coming into the hospital for treatment will be triaged at the door,"Jelalian said. "Those presenting a respiratory illness will be provided masks and tissues, and they will be instructed on how to cover their coughs and sneezes. After an evaluation, the patient will be placed in an isolated area to be seen by a physician."